<!DOCTYPE html>
<html>
	<head>
		<meta charset="utf-8" />
		<meta http-equiv="X-UA-Compatible" content="IE=Edge">
		<title>{$pageData.title}</title>
		<link rel="stylesheet" href="__STATIC__/home/js/layui/css/layui.css" />
		<link rel="stylesheet" href="__STATIC__/home/css/admin.css" />
		<script type="text/javascript" src="__STATIC__/home/js/jquery.min.js"></script>
		<script type="text/javascript" src="__STATIC__/home/js/layui/layui.js"></script>
	</head>
	<body class="pd30" data-id="accountCharge">
		<div class="center-nav f20">充值<a href="{:url('account.show/record_charge')}">充值申请记录</a></div>
        <div class="center-from b-w">
        	<form class="layui-form">
				<ul class="center-from-ul clearfix">
					<li class="width6">
						<div class="layui-form-item">
							<label class="layui-form-label">开户银行</label>
							<div class="layui-input-block">
								<input type="text" name="bank_name" lay-name="开户银行" lay-verify="empty" autocomplete="off" placeholder="请输入开户银行" class="layui-input">
							</div>
						</div>
					</li>
					<li class="width6">
						<div class="layui-form-item">
							<label class="layui-form-label">开户地址</label>
							<div class="layui-input-block">
								<input type="text" name="bank_address" lay-name="开户地址" lay-verify="empty" autocomplete="off" placeholder="请输入开户地址" class="layui-input">
							</div>
						</div>
					</li>
					<li class="width6">
						<div class="layui-form-item">
							<label class="layui-form-label">银行卡号</label>
							<div class="layui-input-block">
								<input type="text" name="bank_card" lay-name="银行卡号" lay-verify="empty" autocomplete="off" placeholder="请输入银行卡号" class="layui-input">
							</div>
						</div>
					</li>
				    <li class="width6">
						<div class="layui-form-item">
							<label class="layui-form-label">开户人</label>
							<div class="layui-input-block">
								<input type="text" name="owner" lay-name="开户人" lay-verify="empty" autocomplete="off" placeholder="请输入开户人" class="layui-input">
							</div>
						</div>
					</li>
					 <li class="width6">
						<div class="layui-form-item">
							<label class="layui-form-label">充值货币</label>
							<div class="layui-input-block">
								<select class="input" name="coin_id" id="accountCharge" lay-verify="required"></select>
							</div>
						</div>
					</li>
					<li class="width6">
						<div class="layui-form-item">
							<label class="layui-form-label">充值金额</label>
							<div class="layui-input-block">
								<input type="text" name="amount" lay-name="充值金额" lay-verify="numb" autocomplete="off" placeholder="充值最小金额：1000元 扣率：-5%" class="layui-input">
							</div>
						</div>
					</li>
					<li class="width6">
						<div class="layui-form-item">
							<label class="layui-form-label">充值时间</label>
							<div class="layui-input-block">
								<input type="text" name="operate_time" lay-name="充值时间" lay-verify="empty" autocomplete="off" placeholder="请输入充值时间" class="layui-input">
							</div>
						</div>
					</li>
					<li class="width6">
						<div class="layui-form-item">
							<label class="layui-form-label">验证码</label>
							<div class="layui-input-block">
								<input type="text" name="captcha" lay-name="验证码" lay-verify="empty" autocomplete="off" placeholder="请输入验证码" class="layui-input">
							</div>
						</div>
					</li>
					<li>
						<div class="layui-form-item">
							<label class="layui-form-label"></label>
							<div class="layui-input-block" id="Verify" onclick="refreshVerify()">
								{:captcha_img()}
							</div>
						</div>
					</li>
					<li class="width6" style="display: none;">
						<input type="hidden" name="token" value="{$token}">
					</li>
				</ul>
				<p class="center-from-p"><input type="button" lay-submit="submit" lay-filter="ChargeSubmit" class="layui-btn layui-bg-orange" value="立即充值"></p>
			</form>
			
		</div>
		<script>
			var charge="{:url('account.handle/charge')}";
			var chargeCoin="{:url('account.api/charge_coin')}";
		</script>
		<script type="text/javascript" src="__STATIC__/home/js/public.js"></script>
	</body>
</html>